Provider Demographics
NPI:1386011963
Name:MASON DIXON SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MASON DIXON SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-262-9711
Mailing Address - Street 1:10212 GOVERNOR LANE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-4086
Mailing Address - Country:US
Mailing Address - Phone:301-733-4200
Mailing Address - Fax:301-223-7121
Practice Address - Street 1:10212 GOVERNOR LANE BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-4086
Practice Address - Country:US
Practice Address - Phone:301-733-4200
Practice Address - Fax:301-223-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical